Br J Pain.
São Paulo, 2018 apr-jun;1(2):180-3
Yamamoto new scalp acupuncture: its applications and results in painful
conditions. Systematic review
Nova crâniopuntura de Yamamoto, suas aplicações e resultados em condições dolorosas.
Revisão sistemática
Dérrick Partrick Artioli1, Marcus Vinícius Gonçalves Torres Azevedo1, Gladson Ricardo Flor Bertolini2
ABSTRACT
BACKGROUND AND OBJECTIVES: The new Yamamoto
craniopuncture is consistently linked to systemic acupuncture or
erroneously described as the Chinese craniopuncture (Chiao Shu
Fa). Its use is mostly described in neurological conditions (i.e.,
stroke). However, there is no single study reviewing its capacity
for analgesic effects compared to other groups, which applica-
tion points are the most used and the quality of the research
developed.
CONTENTS: For this analysis, the databases Pubmed, Pedro
database, Scielo and LILACS were accessed searching for clini-
cal trials with the following keywords: Craniopuncture; Scalp
Acupuncture; Yamamoto New Scalp Acupuncture; Pain (Eng-
lish, Portuguese and Spanish). The AND Boolean index was used
between the selected keyword and pain (e.g., Scalp Acupuncture
AND pain). The only three selected studies were evaluated by
the Jadad score for clinical trials, and most of them have been
considered of poor methodological quality. The Yamamoto New
Scalp Acupuncture was superior to the groups compared (pla-
cebo and control), similar in effects to other interventions (sys-
temic acupuncture and Ai Chi) and the basic points (A-I) were
the most used.
CONCLUSION: At presents, the Yamamoto New Scalp Acu-
puncture present itself as a promising alternative therapy, but
further studies of higher methodological quality are needed for
further conclusions.
Keywords: Acupuncture, Pain, Physical therapy modalities,
Physical therapy specialty, Rehabilitation.
1. Centro Universitário Lusíada, Santos, SP, Brasil.
2. Universidade Estadual do Oeste do Paraná, Cascavel, PR, Brasil.
Submitted in December 04, 2017.
Accepted for publication in April 04, 2018.
Conflict of interests: none – Sponsoring sources: none.
Endereço para correspondência:
Rua Universitária, 2069 – Jardim Universitário
85819-110 Cascavel, PR, Brasil.
E-mail: gladsonricardo@gmail.com
© Sociedade Brasileira para o Estudo da Dor
180
REVIEW ARTICLE
DOI 10.5935/2595-0118.20180035
RESUMO
JUSTIFICATIVA E OBJETIVOS: A nova crâniopuntura de Ya-
mamoto é constantemente vinculada com acupuntura sistêmica
ou descrita erroneamente como crâniopuntura chinesa (Chiao
Shu Fa). Há maior descrição de seu uso em condições neurológi-
cas (ex.: acidente vascular encefálico). No entanto, até o momen-
to, nenhum estudo revisou isoladamente a capacidade de seus
efeitos analgésicos comparados a outros grupos, quais pontos de
aplicação são os mais utilizados e a qualidade das pesquisas de-
senvolvidas.
CONTEÚDO: Para tal análise, as bases de dados Pubmed, Pedro
database, Scielo e LILACS foram acessadas em busca de ensaios
clínicos com as seguintes palavras chaves: Craniopuncture; Scalp
Acupuncture; Yamamoto New Scalp Acupuncture; Pain (Inglês,
Português e Espanhol). O índice booleano AND foi utilizado en-
tre a palavra-chave selecionada e dor (p. ex.: Scalp Acupuncture
AND pain). Os únicos três estudos selecionados, foram avali-
ados pelo escore de Jadad para ensaios clínicos, caracterizando-os
em sua maioria, como de baixa qualidade metodológica. A Nova
Crâniopuntura de Yamamoto mostrou-se superior aos grupos
comparados (placebo e controle), efeito semelhante a outras in-
tervenções (acupuntura sistêmica e Ai Chi) e os pontos básicos
(A-I) foram os mais utilizados.
CONCLUSÃO: No momento, a nova crâniopuntura de Yama-
moto apresenta-se como uma terapia alternativa promissora, mas
que carece de estudos de alta qualidade metodológica para maio-
res conclusões.
Descritores: Acupuntura, Dor, Fisioterapia, Modalidades de fi-
sioterapia, Reabilitação.
INTRODUCTION
In general, regardless the cause, pain is something that all
people will experience at some moment in life, whether it
is an isolated acute episode or chronic (lasting more than
three months). For centuries, systemic acupuncture has been
widely used as a treatment for musculoskeletal conditions as
an adjuvant in the treatment of pain. Using disposable nee-
dles, specific points (based on channels and meridians) are
activated providing a neuromodulatory effect on parts of the
central nervous system (CNS), peripheral and neurotransmit-
ters. This technique is part of the guidelines that recommend
alternatives to manage painful pictures. It does not present
complications regarding drug interactions, feasible in any age
 Yamamoto new scalp acupuncture: its applications and
results in painful conditions. Systematic review
group, and it is a low-cost resource. In addition to the tradi-
tional use that involves the combination of points throughout
several parts of the body, acupuncture also has some deriva-
tions, generating isolated points of treatment (microsystems)1.
If the craniopuncture microsystem is mistakenly listed as part
of the classic systemic acupuncture, the differentiation be-
tween the Japanese practice (Yamamoto New Scalp Acupunc-
ture - YNSA) and the Chinese (Chiao Shun Fa) is seldom
discriminated and analyzed separately. Although being both
on the head, the anatomic interpretation of application sites,
principles and even the way in which the needles are inserted,
differ. In the YNSA, the majority of its points (basic) are on
the patient’s forehead, and in the Chinese craniopuncture, the
application site is on the lateral region of the skull (fronto-
temporal). In the Japanese technique, only the initial mil-
limeters of the tip of the needle is inserted, whereas, in Chiao
Shun Fa, about 2/3 of the needle penetrates the epidermis
parallelly. Although both are described for the treatment of
multiple diagnoses, especially neurological (stroke), there is a
better aggregation of the YNSA analgesic effect in relation to
the Chinese procedure. Therefore, a professional who knows
one of these craniopuncture procedures does not necessarily
master the other2.
YNSA was introduced to the world at the beginning of the
1970s as one microsystem in which the stimulation of points
on the skull creates an effect on other parts of the body, col-
laborating to the treatment of diseases 3. The theory involves
diagnostic regions and therapeutic attribution. YNSA re-
quires a previous diagnosis to determine the sites to be cho-
sen. This is done on the application site (Ashi points on the
skull) or other sites, as, for example, painful points on the
musculature lateral to the neck, abdominal wall or using the
acupuncture point located radially to the metacarpus (IG4).
The treatment zones are all located on the head and divided
into basic points, brain sensorial points, Y points and scalp
pairs4 (Figure 1).
As already described, everyone will eventually experience a
painful situation. Therefore, guidelines, protocols, recom-
mendations, and guides to the therapeutic approach to pain
have been developed1,5,6. Among these, acupuncture is one of
the recommended to manage and handle painful pictures1.
Since YNSA is pointed as a complementary alternative ther-
apy to this condition, it is necessary to analyze the outcomes
that corroborate such statement.
Lee et al.2 conducted a systematic review and meta-analysis of
the craniopuncture in stroke, but up to now, there is one sin-
gle review of the studies related to YNSA and musculoskeletal
pain conditions. In other words, comparisons of the selected
points and the effect of this technique with another interven-
tion have not yet been conducted, not even the methodologic
quality of these research has been analyzed.
The objectives of this study were: (1) to analyze the results
of clinical trials with control group regarding pain using the
YNSA; (2) to determine the most selected points for each
situation, and (3) the methodologic quality of the studies
(Jadad et al. scores)7.
Br J Pain. São Paulo, 2018 apr-jun;1(2):180-3
Basal ganglion point
Cerebellum point Cerebellum point
Brain point Brain point
H
H
I A I
C C
B B
YNSA basic points
Eye
Ear
Nose
Sensory points
Mouth
E E
D D
Midline
Figure 1. Basic points of Yamamoto new scalp acupuncture
A - H, brain and sensorial. A = cervical spine; B = shoulder (shoulder girdle
complex); C = shoulder joint and upper extremity; D = lumbar spine and low
extremity; E = chest; F = ischiatic nerve; G = knee; H = extra lumbar point3.
CONTENTS
The PubMed, Pedro, Scielo, and LILACS database were used.
The following keywords were used in the search: Craniopunc-
ture; Scalp Acupuncture; Yamamoto New Scalp Acupuncture;
Pain (English, Portuguese and Spanish). The Boolean index
AND was used between the selected keyword and pain (i.e.,
Scalp Acupuncture AND pain), directing to pain pictures and
eliminating other variables (motor, sensitive analysis, and func-
tion). These keywords should be found in the title or abstract
of the article for inclusion. Moreover, “Clinical Trials” were one
of the applied filters to eliminate other methodologies that did
not include comparative characteristics of data among groups
and needed to have pain as one of the analyzed variables. Other
exclusion criteria were experiments with animals, Chinese cra-
niopuncture, studies with injuries in the central neurological
system (i.e., stroke and Parkinson disease), and when they were
repeated in the database the analysis was performed in only one
of them. The studies that met the inclusion criteria were evalu-
ated according to the Jadad et al. scale7 for clinical trials, by two
181
Br J Pain. São Paulo, 2018 apr-jun;1(2):180-3 Artioli DP, Azevedo MV and Bertolini GR

professionals with experience in musculoskeletal physiotherapy,
without eliminating the study because of the score, that is, only
indicating the methodologic quality of the article. The software
Statistica 7 was used to analyze the data. Table 1 shows the quan-
titative data of the search.
The analyzed studies indicate superior outcome to the control
group with the YNSA; the basic points were the most used and
the methodologic quality was quantified as low (poor) in its ma-
jority.
Table 2 summarizes the results of the selected clinical trials in
decreasing order, that is, the higher the score indicated by the
Jadad et al. score7, better the methodologic quality of the study.
The outcome of the analyzed studies shows the beneficial and su-
perior effects to the control group when using the YNSA. Only
the study of Rezvani et al.8 with people with headache showed
similarity and not favorable results in comparison to the con-
trol intervention. However, the counter intervention was the
systemic acupuncture, which is cited as one of the ways to man-
age pain10. That is, the results similar to this method cannot be
considered bad since the YNSA is pointed as one microsystem
of acupuncture and that perhaps is better tolerated because it
requires a lesser number of needles8.
The population analyzed by two other studies was patients with
back pain. The Hasegawa et al.4 study, which got the best meth-
odologic score among the analyzed studies, used a control group
Table 1. Search results in the database
Database Found Repeated Excluded Final*
Pubmed 11 2 7
Pedro 11 2 7
Scielo 9 1 7 1
LILACS 13 1 11
Total 44 6 32 6–3=3
* - Selected and analyzed studies; ** - Repeated in another database.
(placebo) very similar to the intervention group. Both groups
performed the same procedure, placing the application mandril
in contact with the skin, and using the same way to select the
points, but without inserting the needle. Clarifying the actual
effect of the YNSA in improving the evaluation parameters com-
pared to the control group and with only 5 sessions of 20 min-
utes. The second study involving back pain also showed to be ef-
fective regarding the reduction of pain in relation to the control
group. However, the use of Ai Chi was as good as the YNSA9.
Accrediting the reduction of pain to the use of the YNSA is prob-
ably due to the activation of the A-delta and C afferent fibers
that generate information in the spinal cord and leads to the
production of dynorphin and enkephalin. These afferent stimu-
lations travel to the CNS releasing neurotransmitters such as se-
rotonin, dopamine, and norepinephrine that when reaching the
hypothalamus and the pituitary gland, release endorphins and
acetylcholine, reducing pain through the descending suppressor
system9,10.
In the selection of the basic points (A - I), which were the most
used in the described studies, the most common way to find
such points is determining the most painful site next to the area
designated as the point function. This strategy seems to work
well to minimize the anatomical differences among individuals3.
However, there is still the possibility of other diagnostic criteria
to select such points, as the access to points in the cervical re-
gion, on the hands (IG4) and abdomen, as Rezvani et al.8 did.
However, this study did not make it clear if the needles had been
inserted unilaterally or bilaterally in the selected points. On the
other hand, Hasegawa et al.4 applied them bilaterally and Cami-
2
lotti et al.9 unilaterally. Moreover, this makes it difficult to deter-
2**
mine any influence in the effect due to the divergence between
the authors regarding the side of the application. Some authors
1** advocate the insertion of the needles on the most painful homo-
lateral side of the IG4 point (systemic acupuncture)11. However,
in the light of this, the variability of the diagnostic types pos-

Table 2. Characteristics of the analyzed clinical trials

Authors Objectives Counter intervention Population YNSA points Duration and sessions Jadad Results
Hasegawa The effectiveness Placebo Non-specific Basic: D; D1-D6; 20 min; 5 sessions 3 Superior
et al.4 of the YNSA in pain acute back H; I. to the CG
(VAS), use of anal- pain Y: Bladder; Kid- (p<0.05)
gesics (frequency), 80 patients: IG ney; Liver
functional capaci- (40) and CG PD (cervical):
ty (Roland-Morris (40) Kidney; Bladder;
Questionnaire) and Liver
quality of life (SF-36)
Rezvani et Therapeutic effect Systemic Chinese 80 patients Basic: A1-7; C: 30 min; 18 sessions 2 Similar to
al.8 in the prophylaxis Traditional Acu- with headache: M1-3; the CG
and treatment of puncture (CTA) 40 CTA (CG) Y: not described; (p>0.05)
headache (VAS and and 40 YNSA PD: hands, cervi-
MTAQ) cal and abdomen
Camilotti Effectiveness of Ai Chi and CG Chronic back Basic: D; D1-D5. 20 min; 10 sessions 1 Superior
et al.9 YNSA and Ai Chi pain (2/wk) to the CG
regarding pain (VAS) 44 patients: Ai and similar
and functional ca- Chi (15); YNSA to Ai Chi
pacity (Owestry) (15); CG (14) (p<0.05)
YNSA = Yamamoto New Scalp Acupuncture; VAS = visual analog scale; CG = control group; IG = intervention group; Y = ipsilon; C = brain; PD = diagnostic points;
wk = week; MTAQ = Migraine Therapy Assessment Questionnaire.

182
 Yamamoto new scalp acupuncture: its applications and
results in painful conditions. Systematic review
sibly contributes to different decision making without having a
method that is considered superior to the other.
The YNSA, unlike other strategies of care, requires smaller physi-
cal space for its application (the patient can remain seated) and it
uses low-cost input as described by Hasegawa et al.4. Moreover,
the effects can be noticed within few sessions and even immedi-
ate effects have been described3,4. The application duration is not
long (20-30 minutes, with periodic stimulation) which does not
greatly interfere with other procedures, making it easy to be used
in hospital wards and outpatient settings, specialized clinics, ba-
sic care units, public rehab centers or private clinics. Although
promising, the YNSA lacks the development of high methodo-
logic quality research to determine its level of contribution to the
treatment of pain. Since it was not superior to the systemic acu-
puncture in the Rezvani et al.8 study (providing the same benefits
to the patient) and in the other two studies where it showed to
be an advantageous method, the methodologic quality of one of
them was bad (Jadad = 1).
As limitations of the present study, we can indicate the scarcity of
clinical trials in the western database analyzed and the inclusion
of eastern database could get a bigger number of studies for anal-
ysis. In this attempt, the Japanese National Institute of Informat-
ics Scholarly and Academic Information Navigator (CiNii) was
accessed. However, the language (Japanese) made it impossible
for the authors to analyze the studies, some involved animals or
were not freely available in full. Likewise, German12 and Chinese
studies could not be analyzed due to the authors’ limitations.
Nevertheless, other studies11,13,14 were excluded because they did
not meet the assigned methodology, such as not using a control
group or using the Chinese Craniopuncture15-19.
CONCLUSION
The YNSA seems to be a promising technique that has ben-
eficial effects in painful conditions in the lumbar region, es-
pecially non-specific acute back pain, being the (A-I) basic
points the most used with results in few sessions (immediate
or 5 to 18 sessions), with a satisfactory application duration
(20-30 minutes) and low cost. It can be considered an alter-
native or complementary therapy with perspectives of good
Br J Pain. São Paulo, 2018 apr-jun;1(2):180-3
results, but it lacks more scientific base with studies of high
methodologic quality.
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